Hundreds of people are expected at the Utah State Capitol Thursday afternoon to rally for those with substance abuse and mental health disorders. Advocates will be calling attention to a shortage in public funding for treatment, and they’ll be asking lawmakers to expand Medicaid. As part of an ongoing series, KUER looks at Utahns who don't have access to Medicaid or health insurance subsidies and fall in a coverage gap. In today’s installment, we meet a Salt Lake City man in recovery from heroin addiction.
He showed up at the Emergency Room threatening to commit suicide. He hardly recognized himself. It wasn’t just the abscesses on his arms, and the weight he had lost living on the streets, he says heroin had turned him into a different person.
“I never thought I would be committing crimes. I had a great upbringing, I was taught morals and ethics. I never thought I would be doing the things I was doing.” Adam – who did not want to use his real name for this story - says he came from an affluent, educated family. He went to college in New York City, got an art degree. He was working in LA, when he came to Salt Lake City to stay with family and get away from heroin. But he found the drug was all too easy to get. Soon his family kicked him out, and he was homeless.
“I used to judge homeless people, and I quickly became one of those people,” Adam says. “I was living at the shelter. It got to a point where my addiction became so bad, where every day I would hustle, I would walk around the city and either panhandle or I would steal - every single day just to feed my addiction.”
Adam says he lived like that for about three years. He wanted to quit, but every time he would visit a detox facility, he would leave a day or two later and be back on the street. He says withdrawal from heroin made him unbearably sick. He visited the emergency room numerous times for infected abscesses from using dirty needles, pancreatitis, hepatitis C. The last time he came to the ER saying he wanted to die, they kept him for 8 days, gave him suboxone and helped him medically detox. Adam says he couldn’t afford it, but he desperately needed it.
“It probably cost me 20,000 dollars which I have no way of paying now, but to me it was worth it because that was the start of my recovery,” he says.
When I met Adam, he was at a recovery center called First Step House. It’s a converted old church on the west side of Salt Lake City, with large windows and about 60 beds. Some of the men there are recently out of jail, some are military veterans - all are working to overcome addiction. Adam says he’s gained 30 pounds since he arrived a couple months back. Under his baseball cap and glasses, his blue eyes are steady and clear.
“I get to wake up every day and be sober, and don’t have to worry about what kind of crimes I’m going to commit today to go get some heroin so I’m not sick. I’m healthy,” Adam says. “I have a whole group of friends in recovery that support me and we help each other, my family’s talking to me again. Everything is coming back very quickly just because First Step allowed me to come here with no resources whatsoever.”
Adam says he has about $75,000 in medical debt, but he still counts himself as one of the lucky ones. For every successful recovery like Adam, there are more who fall through the cracks. There are about 60 people on the wait list to get in to the center, and First Step House Admissions Director Raye Silvers says depending on the situation, it can take a week or up to six months to get in. For those with substance use problems, that wait can be too long.
“Without a safe place to be, and without appropriate supportive services, and in many cases medical care, they simply can’t maintain, and so, they’re out on the streets doing whatever they have to do, and I’m unable to find them,” Silvers says.
It costs about $3000 a month for each client at First Step House. Those on the wait list are counting on limited funding from Salt Lake County, but Silvers says people call from all over the state because many counties don’t have the same services.
“A lot of days, all I do is talk to people that I can’t help, and I have to say no, or I have to say go over here to call these people and see what they can do – knowing that in all likelihood they can’t receive any help there either,” Silvers says.
This frustration goes all the way to the top of county government.
“It really comes down to dollars right now. We just don’t have the ability to cover all the need that’s out there,” says Pat Fleming, Director of Behavioral Health Services for Salt Lake County.
“We’ve had more and more of a demand for services that we have and yet the amount of dollars that we have through a variety of public services has really not increased at the same rate as the demand has increased,” Fleming says.
He says many Utahns with substance use disorder and mental illness don’t have access to health insurance or Medicaid, so it’s the county that steps in to support them. Counties are funded largely through property taxes, and Salt Lake County has not fared well after the recession. Fleming says they have been able to maintain services up until now by cutting staff and costs, but he says there is nothing left to cut. Now the county faces a crisis in funding for behavioral health services. The department is anticipating an 11 percent budget shortfall this summer. That means they will have to cut services, and about 500 county clients will not get the help they need.
“Somebody’s got to do something, or we’re going to have to cut almost 1.8 million dollars out of services on July 1st, just at the very time when there are more and more people coming in for care,” Fleming says.
Fleming and other county officials say they are relying on state lawmakers to expand Medicaid or find some other way to get coverage for those under the poverty line. If not, they say the wait lists at First Step House will only get longer, and people like Adam will still be relying on the emergency room to get care.
Adam says without the medical detox treatment and the recovery center, he would still be on the streets, and he knows what happens out there.
“I’ve been here two months, and I already know of two friends that have died from heroin overdose out there that wanted treatment,” Adam says. “They don’t have the funding or they have to wait too long and it’s just too late.”
Governor Gary Herbert has said there is no rush to make a decision on whether to expand Medicaid in Utah, but he’s also said that doing nothing is not an option. While conservative state lawmakers are loathe to accept federal money – especially in association with the Affordable Care Act - they are working to come up with some way to fill the coverage gap in Utah. Those who deliver county services are crossing their fingers that they find a solution… and soon.